<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html>
<head id="header">
<title>投诉登记单</title>
<meta http-equiv="keywords" content="北京工商局无障碍网站,北京工商局无障碍" />
<meta http-equiv="description" content="北京工商局无障碍网站" />
<meta http-equiv="content-type" content="text/html; charset=utf-8" />
<script type="text/javascript" src="../etc/js/jquery-1.11.1.min.js"></script>
<script type="text/javascript" src="../etc/js/tsdj.js"></script>
<script type="text/javascript" src="../etc/js/date.js"></script>
<script type="text/javascript" src="../etc/js/date2.js"></script>
<script type="text/javascript" src="../etc/js/public.js"></script>
<script type="text/javascript" src="../etc/My97DatePicker/WdatePicker.js"></script>
<link rel="stylesheet" type="text/css" href="../etc/styles/public.css" />
<link rel="stylesheet" type="text/css" href="../etc/styles/tsdj.css" />
</head>

<body>
	<include src="header.html" />
	<div class="main">
		<form action="" method="post" onsubmit="return submitPage();">
			<table class="erjibg">
				<tbody>
					<tr>
						<td>
							<div class="title">投诉登记单</div>
						</td>
					</tr>
					<tr>
						<td>
							<table>
								<tbody>
									<tr>
										<td class="left_td">消费者信息：</td>
										<td></td>
									</tr>
									<tr>
										<td class="first_td">姓名:</td>
										<td class="after_td">
											<input id="name" type="text" name="name" title="请输入姓名 必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入姓名"/>
											<span style="color: red;">&nbsp;&nbsp;*</span>
										</td>
									</tr>
									<tr>
										<td class="first_td">性别:</td>
										<td class="after_td">
										<input type="radio" name="gender" value="0" title="请选择性别" checked="checked" />男
										&nbsp;&nbsp; 
										<input type="radio" name="gender" value="1" title="请选择性别" />女</td>
									</tr>
									<tr>
										<td class="first_td">联系电话:</td>
										<td class="after_td"><input id="phone" type="text" name="phone" title="请输入联系电话 必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入联系电话"/><span style="color: red;">&nbsp;&nbsp;*</span>
										</td>
									</tr>
									<tr>
										<td class="first_td">通讯地址:</td>
										<td class="after_td"><input id="adress" type="text" name="adress" title="请输入通讯地址 非必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入通讯地址"/>
										</td>
									</tr>
								</tbody>
							</table></td>
					</tr>
					<tr>
						<td>
							<table>
								<tbody>
									<tr>
										<td class="left_td">被投诉方信息:</td>
										<td></td>
									</tr>
									<tr>
										<td class="first_td">名称:</td>
										<td class="after_td">
											<input id="designation" name="designation" type="text" title="请输入被投诉方名称 必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入名称"/><span style="color: red;">&nbsp;&nbsp;*</span>
										</td>
									</tr>
									<tr>
										<td class="first_td">地址:</td>
										<td class="after_td">北京市&nbsp;&nbsp;
										<select id="city" title="请选择被投诉方地址">
												<option value="110102">西城区</option>
												<option value="110101">东城区</option>
												<option value="110103">崇文区</option>
												<option value="110104">宣武区</option>
												<option value="110105">朝阳区</option>
												<option value="110116">怀柔区</option>
												<option value="110108">海淀区</option>
												<option value="110106">丰台区</option>
												<option value="110107">石景山区</option>
												<option value="110109">门头沟区</option>
												<option value="110111">房山区</option>
												<option value="110112">通州区</option>
												<option value="110113">顺义区</option>
												<option value="110115">大兴区</option>
												<option value="110228">密云县</option>
												<option value="110114">昌平区</option>
												<option value="110117">平谷区</option>
												<option value="110229">延庆县</option>
												<option value="110230">燕山</option>
										</select><span style="color: red;">&nbsp;&nbsp;*</span> 
										<input id="local" name="local" type="text" title="请输入被投诉方地址 必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入地址"/>
										<span style="color: red;">&nbsp;&nbsp;*</span></td>
									</tr>
									<tr>
										<td class="first_td">联系电话:</td>
										<td class="after_td">
											<input id="number" name="number" type="text" title="请输入联系电话 非必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入联系电话"/>
										</td>
									</tr>
								</tbody>
							</table></td>
					</tr>
					<tr>
						<td>
							<table>
								<tbody>
									<tr>
										<td class="left_td">投诉内容:</td>
										<td></td>
									</tr>
									<tr>
										<td class="first_td">商品/服务:</td>
										<td class="after_td">
										<input name="goods" type="radio" title="请选择投诉内容" value="1" checked="checked" />商品
										&nbsp;&nbsp;&nbsp; 
										<input name="goods" type="radio" title="请选择投诉内容" value="2" />服务</td>
									</tr>
									<tr>
										<td class="first_td">商品/服务名称:</td>
										<td class="after_td">
											<input id="goods_name" name="goods_name" type="text" title="请输入商品或服务名称 必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入商品或服务名称"/><span style="color: red;">&nbsp;&nbsp;*</span>
										</td>
									</tr>
									<tr>
										<td class="first_td">品牌:</td>
										<td class="after_td"><input id="brand" name="brand" type="text" title="请输入品牌 非必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入品牌"/></td>
									</tr>
									<tr>
										<td class="first_td">型号:</td>
										<td class="after_td"><input id="model" name="model" type="text" title="请输入型号 非必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入型号"/></td>
									</tr>
									<tr>
										<td class="first_td">数量:</td>
										<td class="after_td"><input id="count" name="count" type="text" title="请输入数量 非必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入数量"/></td>
									</tr>
									<tr>
										<td class="first_td">商品/服务价格:</td>
										<td class="after_td"><input id="price" name="price" type="text" title="请输入商品或服务价格 非必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'}" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" style="color:#999999" value="请输入商品或服务价格"/></td>
									</tr>
									<tr>
										<td class="first_td">凭证:</td>
										<td class="after_td">
										<select id="voucher" name="voucher" title="请选择">
												<option value="发票">发票</option>
												<option value="收据">收据</option>
												<option value="合同">合同</option>
												<option value="其他">其他</option>
										</select><span style="color: red;">&nbsp;&nbsp;*</span></td>
									</tr>
									<tr>
										<td class="first_td">购买(接收服务)时间:</td>
										<td class="after_td">
											<select id="year" name="year" title="请选择购买(接收服务)年份" onChange="swap_day()"></select>
											<select id="month" name="month" title="请选择购买(接收服务)月份" onChange="swap_day()"></select>
											<select id="day" name="day" title="请选择购买(接收服务)日期"></select>
<!-- 											<input id="buy_time" name="buy_time" type="text" class="Wdate" onfocus="WdatePicker({dateFmt:'yyyy-MM-dd'})" readonly="readonly" title="请选择 购买(接收服务)时间:"/> -->
											&nbsp;&nbsp;
											<span style="color: red;">
											<span style="color: red;">
											&nbsp;&nbsp;*
											</span>注：有效期一年</span>
										</td>
									</tr>
									<tr>
										<td class="first_td">事件发生时间:</td>
										<td class="after_td">
											<select id="year2" name="year" title="请选择事件发生年份" onChange="swap_day2()"></select>
											<select id="month2" name="month" title="请选择事件发生月份" onChange="swap_day2()"></select>
											<select id="day2" name="day" title="请选择事件发生日期"></select>
<!-- 											<input id="happen_time" name="happen_time" type="text" class="Wdate" onfocus="WdatePicker({dateFmt:'yyyy-MM-dd'})" readonly="readonly" title="请选择 事件发生时间:"/> -->
											<span style="color: red;">&nbsp;&nbsp;*</span>
										</td>
									</tr>
									<tr>
										<td class="first_td">简要情况:</td>
										<td class="after_td">请不要超过400个汉字（包括标点）</td>
									</tr>
									<tr>
										<td class="first_td"></td>
										<td class="after_td">
										<textarea id="content" name="content" rows="10" cols="80" title="请输入简要情况 必填项" onFocus="if(value=='请不要超过400个汉字（包括标点）'){value='';this.style.color='#000'}" onBlur="if(!value){value='请不要超过400个汉字（包括标点）';this.style.color='#999'}" style="color: #999;">请不要超过400个汉字（包括标点）</textarea>
										<span style="color: red;">&nbsp;&nbsp;*</span>
										</td>
									</tr>
									<tr>
										<td class="first_td">验证码:</td>
										<td class="after_td">
											<input id="code" type="text" title="请输入验证码 必填项" onFocus="if(value==defaultValue){value='';this.style.color='#000'};esdonfocus();" onBlur="if(!value){value=defaultValue;this.style.color='#999'}" value="请输入验证码" style="color: #999;"/><img id="verifyImage" title="验证码" alt="验证码" /><a href="static:javascript:esdonfocus();" title="播放验证码"><img id="audio" src="../etc/image/volume2.png" alt="播放验证码" title="播放验证码" /></a><input type="hidden" id="voicepath" />
										</td>
									</tr>
									<tr>
										<td class="first_td">注意:</td>
										<td class="after_td">
											(1) 、请您如实按要求填写投诉登记单的内容,简要情况栏不要超过400个汉字（包括标点）<br />
											(2) 、标有“*”的信息项，请您务必填写内容，否则申诉登记单无法提交。<br />
											(3) 、请使用IE7,8,9版本以及IE内核浏览器进行填写（其他浏览器可能会出现不兼容的情况）
										</td>
									</tr>
									<tr>
										<td colspan="2">
										<input type="submit" value="提交" title="提交"/>
										<input value="重置" type="reset" name="ResetButton" id="ResetButton" title="重置">
										</td>
									</tr>
								</tbody>
							</table></td>
					</tr>
				</tbody>
			</table>
		</form>
	</div>
	<script type="text/javascript" src="../etc/tool/Voice.js"></script>
	<include src="footer.html" />
</body>
</html>